Provider Demographics
NPI:1588244628
Name:SPONSELLER, MARA CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:CATHERINE
Last Name:SPONSELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:CATHERINE
Other - Last Name:NICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1775 W LEXINGTON STE 150
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3668
Mailing Address - Country:US
Mailing Address - Phone:513-246-8000
Mailing Address - Fax:513-853-7909
Practice Address - Street 1:1775 W LEXINGTON STE 150
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3668
Practice Address - Country:US
Practice Address - Phone:513-246-8000
Practice Address - Fax:513-853-7909
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.150515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program